Difference between revisions of "Paresthesia"

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{{DiseaseDisorder infobox |
  Name        = Paresthesia |
  ICD10      = {{ICD10|R|20|2|r|20}} |
  ICD9        = {{ICD9|782.0}}, {{ICD9|355.1}} |
{{Editor Help}}
{{SK}} Paraesthesia
== [[Paraesthesia overview|Overview]] ==
'''Paresthesia''' or '''paraesthesia''' (in [[British English]]) is a [[sensation]] of [[Wiktionary:tingling|tingling]], [[Wiktionary:pricking|pricking]], or '''[[Wiktionary:numbness|numbness]]''' of a [[person]]'s [[skin]] with no apparent long-term physical effect, more generally known as the feeling of '''pins and needles''' or of a [[human limb|limb]] being "asleep" (but not directly related to the phenomenon of [[sleep]]). Its manifestation may be transient or chronic.
== [[Paraesthesia historical perspective|Historical Perspective]]==
Numbness, tingling and abnormal sensations potentially occur secondary to lesions anywhere in the nervous system. They may be accompanied by a decreased sensation that can be noticed by exposure to painful stimuli.
== [[Paraesthesia pathophysiology|Pathophysiology]] ==
==Chronic condition==
== [[Paraesthesia causes|Causes]] ==
Chronic paresthesia indicates a problem with the functioning of [[neuron]]s. This malfunction, which is especially common in older individuals, is often the result of poor [[Circulation (physiology)|circulation]] in the limbs (such as in peripheral vascular disease), which may be caused by [[atherosclerosis]] — the build up of [[plaque]] on [[artery]] walls. Without a proper supply of [[blood]] and [[nutrients]], nerve cells can no longer adequately send signals to the [[brain]]. Because of this, paresthesia can also be a symptom of [[vitamin]] deficiency and [[malnutrition]], as well as [[metabolism|metabolic]] disorders like [[Diabetes mellitus|diabetes]], [[hypothyroidism]], and [[hypoparathyroidism]].
Irritation to the nerve can also come from [[inflammation]] to the surrounding tissue. Joint conditions such as [[rheumatoid arthritis]] and [[carpal tunnel syndrome]] are common sources of paresthesia.
== [[Paraesthesia risk factors|Risk Factors]] ==
Another cause of paresthesia, however, may be direct damage to the nerves themselves, or [[neuropathy]], which can stem from [[injury]] or [[infection]] such as [[Lyme disease]], or which may be indicative of a current [[neurological disorder]]. Chronic paresthesia can sometimes be symptomatic of serious conditions, such as a [[transient ischemic attack]], a [[brain tumor]], [[motor neurone disease]], or [[autoimmune disorder]]s like [[multiple sclerosis]] or [[lupus erythematosus]]. A diagnostic evaluation by a [[medical doctor|doctor]] is necessary to rule these out.
== [[Paraesthesia natural history, complications and prognosis|Natural History, Complications and Prognosis]] ==
Paresthesiae of the [[mouth]], hands, and feet are common, transient symptoms of the related conditions of [[hyperventilation syndrome]] and [[panic attack]]s.
== Diagnosis ==
== Diagnosis ==
[[Paraesthesia history and symptoms|History and Symptoms]] | [[Paraesthesia physical examination|Physical Examination]] | [[Paraesthesia laboratory findings|Laboratory Findings]] | [[Paraesthesia chest x ray|Chest X Ray]] |[[Paraesthesia CT|CT]] | [[Paraesthesia MRI|MRI]] | [[Paraesthesia other imaging findings|Other Imaging Findings]] | [[Paraesthesia other diagnostic studies|Other Diagnostic Studies]]
=== History and Symptoms ===
== Treatment ==
*A complete physical exam and history is necessary
:*Anatomic distribution
:*Personal history
:*Negative symptoms ([[weakness]], pain etc.)
=== Laboratory Findings ===
[[Paraesthesia medical therapy|Medical Therapy]] | [[Paraesthesia surgery|Surgery]] | [[Paraesthesia primary prevention|Primary Prevention]]
*Labs include:
:*[[Glycohemoglobin|Hemoglobin A1C]]
:*[[Vitamin B12]]
==== Electrolyte and Biomarker Studies ====
*Nerve conduction studies
==== Chest X Ray ====
*[[Chest X ray]] is indicated for differential diagnosis.
==== Other Imaging Findings ====
*[[Electromyography]] - aids in muscular atrophy differentiation
== Differential Diagnosis of Causes of {{PAGENAME}}==
*Acute idiopathic [[polyneuritis]]
*[[Alcoholic neuropathy]]
*[[Alcoholism]] and [[alcohol withdrawal]]
*[[Amyotrophic lateral sclerosis]]
*[[Anticonvulsant]] [[medication|drugs]] such as [[topiramate]], [[sulthiame]], and [[acetazolamide]]
*[[Brain tumor]]
*[[Carpal Tunnel Syndrome]]
*Cerebrovascular insult
*[[Charcot-Marie-Tooth Syndrome]]
*[[Collagen vascular disease]]
*[[Diabetes Mellitus]]
*Entrapment [[neuropathy]]
*[[Fabry disease]]
*[[Guillain-Barre Syndrome]] (GBS)
*[[Head trauma]]
*[[Heavy metals]]
*[[Hereditary]] [[neuropathy|motor neuropathies]]
*[[Herpes Zoster]]
*[[Immune]] deficiency, such as [[Chronic inflammatory demyelinating polyneuropathy]] (CIDP)
*[[Lidocaine]] poisoning
*[[Lyme Disease]]
*[[Multiple sclerosis]]
*[[Nerve]] compression
*Peroneal palsy
*[[Polyarteritis Nodosa]]
*[[Radiation poisoning]]
*[[Sjogren's Syndrome]]
*[[Systemic sclerosis]]
*[[Tarsal tunnel]]
*[[Throacic outlet syndrome]]
*[[Trigeminal neuralgia]]
*Ulnar entrapment
*[[Vitamin B12 deficiency]]
*[[Withdrawal]] from certain [[SSRI]]s, such as [[Paroxetine]]
Treatment should be decided by a [[neurologist]].  Medications offered can include [[prednisone]], intravenous [[gamma globulin]] (IVIG) and [[anticonvulsants]] such as [[gabapentin]] or [[gabitril]], amongst others.
In some cases, rocking the head from side to side will painlessly remove the "pins and needles" sensation in less than a minute. A tingly hand or arm is often the result of compression in the bundle of nerves in the neck. Loosening the neck muscles releases the pressure. Compressed nerves lower in the body govern the feet, and standing up and walking around will typically relieve the sensation. <ref>http://health.msn.com/menshealth/articlepage.aspx?cp-documentid=100119940&GT1=7538</ref>
An arm that has "fallen asleep" may also be "awoken" more quickly by clenching and unclenching the fist several times; the muscle movement increases blood flow and helps the limb return to normal.
In general;
*Support vitamin deficiency
*Treat infections or diseases that may be underlying
=== Pharmacotherapy ===
==== Acute Pharmacotherapies ====
*NSAIDs, acetominophin, epidural steroids (if severe)
*Painful peripheral neuropathies - treat with amitriptyline,desipramine, phenytoin, carbamezapine or topical capsaicin cram
=== Surgery and Device Based Therapy ===
==== Indications for Surgery ====
*Surgical tumor removal
*Release of trapped nerve or disc
==Case Studies==
:[[Paraesthesia case study one|Case #1]]
==External links==
==External links==
* {{NINDS|paresthesia}}
* {{NINDS|paresthesia}}
{{Symptoms and signs}}
[[Category:Signs and symptoms]]
[[Category:Primary care]]
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Latest revision as of 18:47, 7 February 2013